RELATING TO MEDICAL BILLING.

HB2536

HOUSE OF REPRESENTATIVES

H.B. NO.

2536

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

RELATING
TO MEDICAL BILLING
.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

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SECTION 1.
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The legislature finds that timely payment of
healthcare insurance claims is essential to the financial stability of
healthcare providers and to maintaining patients' access to care throughout the
State.
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Delayed payment of "clean"
claims that are complete, well-documented, and uncontested shifts the financial
risk from insurers to healthcare providers, often forcing medical practices to
borrow funds to meet payroll and operating expenses and threatening the
availability of healthcare services, particularly in rural and underserved
communities.

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The legislature further finds that
under Hawaii's existing prompt payment statute, section 431:13-108, Hawaii
Revised Statutes, clean claims must be reimbursed within thirty days or less,
and clean claims that are not timely reimbursed are subject to an annual
interest rate of fifteen per cent.
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However, enforcement of the statute is fragmented
and largely driven by complaints.
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In
addition, the statute lacks a dedicated regulatory authority with specialized
expertise in healthcare insurance to provide proactive oversight.

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Accordingly, the purpose of this Act
is to establish the office of payment monitoring within the department of
commerce and consumer affairs to enforce, monitor, audit, and collect data
regarding the prompt payment obligations of health or sickness insurers.

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SECTION 2.
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Chapter 431, Hawaii Revised Statutes, is
amended by adding a new section to article 13, part I, to be appropriately
designated and to read as follows:

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"
�431:13-
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Office of payment monitoring.
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(a)
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There is established the office of payment
monitoring within the department of commerce and consumer affairs for
administrative purposes.

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(b)
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The office of payment monitoring shall:

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(1)
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Proactively
monitor the status of reimbursements under section 431:13-108;

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(2)
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Enforce
penalties for clean claim reimbursements that are accruing interest under
section 431:13-108; and

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(3)
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Collect data on
and conduct audits of reimbursements made by health or sickness insurers.

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(c)
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The governor shall appoint an administrator
of the office of payment monitoring in the manner provided by section 26-34.
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No individual shall be employed by any health
or sickness insurer, claims administrator, or entity subject to the
jurisdiction of the office of payment monitoring within two years of the individual's
last day of employment as the administrator of the office of payment
monitoring.

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(d)
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The office of payment monitoring shall submit
a report to the legislature no later than twenty days prior to the convening of
each regular session.
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The report shall
include:

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(1)
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A summary of
the office's activities for the prior fiscal year;

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(2)
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A summary of
the status of reimbursements under section 431:13-108 for the prior fiscal
year; and

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(3)
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Any proposed
legislation.
"

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SECTION
3.
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There is appropriated out of the
general revenues of the State of Hawaii the sum of $
or so much thereof as may be necessary for fiscal year 2026-2027 for the
establishment and functions of the office of payment monitoring, including the
hiring of full-time permanent (
FTE) positions.

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The sum
appropriated shall be expended by the department of commerce and consumer
affairs for the purposes of this Act.

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SECTION
4.
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New statutory material is
underscored.

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SECTION 5.
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This Act shall take effect on July 1, 2026.

INTRODUCED BY:

_____________________________

Report Title:

Health
Insurance; DCCA; Office of Payment Monitoring; Prompt Payment; Reimbursement;
Appropriation

Description:

Establishes
the Office of Payment Monitoring within the Department of Commerce and Consumer
Affairs to monitor and enforce prompt payment of clean claims for reimbursement
from health or sickness insurers.
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Appropriates moneys.

The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.